Hypothyroid vs Hashimoto’s: What’s the difference?

Are you suffering from Hashimoto's or hypothyroidism?

Do you completely understand what these conditions mean and how they impact your body?

Did you know that these conditions are different and may require different treatments?

In this article, I'm going to explain the difference between these two conditions and discuss why it's important to know what is happening in your body. 

Highlights from the article:

  • Hypothyroidism and Hashimoto's thyroiditis are similar but not the exact same.
  • Hypothyroidism is a broad term used to describe a state of low thyroid function in the body. Some patients with Hashimoto's may also have hypothyroidism, but having Hashimoto's does not guarantee that you will be hypothyroid. 
  • Hashimoto's thyroiditis is an autoimmune disease and may be associated with episodes of hyperthyroidism, normal thyroid function, and hypothyroidism. 
  • Both conditions are treated differently so it's important to know which condition you have!

More...

Hypothyroidism and Hashimoto's are Similar but Different

Let's first start by defining hypothyroidism because it is easier to understand compared to Hashimoto's. 

Hypothyroidism simply refers to a state of low thyroid function in the body. 

This state is almost always the result of decreased thyroid hormone production directly from the thyroid gland, but it can also be from resistance to thyroid hormone at the cellular level (this one is rare though, so let's focus more on the thyroid gland production issue). 

It's pretty simple actually:

Whenever your thyroid gland, which sits in your neck, can't produce enough thyroid hormone for your body and cells you will experience the symptoms of hypothyroidism

These symptoms include things like fatigue, weight gain, hair loss, cold intolerance, constipation, other hormone issues, and so on. 

But saying you have hypothyroidism is not very specific because there are a great many things which can cause hypothyroidism including Hashimoto's. 

outline of thyroid function and thyroid gland activity in the body

But while Hashimoto's can cause hypothyroidism, there are also many many other things that can lead to this state of disordered thyroid hormone production (some of the causes are listed below). 

Knowing you have hypothyroidism is important, though, because that means that something is necessary to fix that problem. 

Most of the therapies for hypothyroidism are directed at trying to improve how much thyroid hormone is floating around in your body. 

You can do this by using natural therapies (listed here) or you can do it by taking thyroid hormone medication

The big difference between hypothyroidism (the state of low thyroid function in the body) and Hashimoto's, is that both Hashimoto's and hypothyroidism can co-exist together but they don't necessarily have to. 

It's possible for you to have both hypothyroidism and Hashimoto's, but it's also possible for you to have Hashimoto's and not be in a state of hypothyroidism. 

Remember:

Hypothyroidism and hyperthyroidism only refer to the state of thyroid function and activity in your body, they don't tell you anything about what caused the problem. 

And this is a big deal because understanding the cause of your condition helps to guide your treatment. 

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Hashimoto's Explained

While hypothyroidism and Hashimoto's are not the same thing it's important to realize that the vast majority of cases of hypothyroidism are caused by Hashimoto's. 

This is true simply because the most common cause of hypothyroidism is Hashimoto's thyroiditis. 

It is estimated that roughly 60-80% of all cases of hypothyroidism are due to this autoimmune condition (1). 

So, if you are reading this, there is a good chance that you may have hypothyroidism caused by Hashimoto's without even realizing it. 

How can this be?

I discuss why in the section below. 

There are some important distinctions between hypothyroidism and Hashimoto's that we should touch on now. 

The first is that Hashimoto's is an autoimmune condition caused by the attack of your own immune system on your thyroid gland (2). 

This autoimmune attack, if not suppressed or treated, may ultimately lead to the permanent destruction of your thyroid gland. 

The second is that Hashimoto's is associated with more than just hypothyroidism. 

Patients with Hashimoto's often experience episodes of hypothyroidism, hyperthyroidism, and even normal thyroid function. 

This roller coaster of symptoms is often VERY frustrating for patients because you can go from feeling "normal" to gaining 5-10 pounds in the course of a month

The reason for this has to do with how autoimmune conditions influence your thyroid. 

Hashimoto's damages your thyroid from inflammation, but this inflammation doesn't always ensure that your thyroid gland will be unable to produce less thyroid hormone. 

Sometimes this inflammation results in the release of MORE thyroid hormone which causes hyperthyroidism. 

And sometimes, due to reasons we don't fully understand, your thyroid can become completely normal and not cause you any issues. 

When treating Hashimoto's (something I touch on below), the entire goal is to try and harness that state and reduce immune attack and damage on your thyroid gland. 

Third, the causes of Hashimoto's are different from those things which cause hypothyroidism. 

Hypothyroidism can be caused by (3):

  • Nutrient and iodine deficiencies
  • Removal of the thyroid gland or exposure to radioactive iodine
  • Severe dieting or calorie restriction
  • Obesity
  • Certain medications
  • Damage to your pituitary or hypothalamus (certain parts of your brain)
  • Damage to the thyroid gland from trauma
  • Inflammation in the thyroid gland from infection (virus or bacterial)
  • Being born without a thyroid gland

Hashimoto's, on the other hand, is often caused by the following:

potential causes of hashimoto's thyroiditis

And lastly, Hashimoto's should be differentiated from hypothyroidism because it is a potentially reversible cause of hypothyroidism. 

Not all cases of Hashimoto's will necessarily progress to hypothyroidism (even without treatment). 

There is a small chance that your body can recover (10), that your immune system can stabilize, and that you will no longer suffer from this debilitating condition.

This can even happen in the absence of treatments or therapies!

Now that we are getting into treatment territory, let's go into a little more detail.

Treatment is Different for Each Condition

Perhaps the most important distinction between these two conditions is the fact that each one is treated differently!

This may come as a surprise to you, however, because most physicians are not concerned about distinguishing between hypothyroidism and Hashimoto's. 

I'll explain why:

Doctors, including endocrinologists, believe that it isn't necessary to treat Hashimoto's for two main reasons. 

The first is the fact that autoimmune diseases can't really be treated with conventional medicines (but that doesn't mean they can't be treated with natural therapies such as diet, stress reduction, supplements, exercise, and so on). 

The second is because they feel that most cases of Hashimoto's will ultimately end up causing hypothyroidism and that you will eventually need to be on thyroid medication anyway. 

So, the logic goes, let's just wait until your thyroid gland is destroyed enough that it impacts thyroid function negatively and put you on thyroid medication and then call it a day. 

This obviously doesn't sit well with most people who would like to at least try to prevent this damage from occurring. 

And, believe it or not, there are a great many people who strongly believe (I happen to be one of them) that certain therapies may be able to prevent the so-called inevitable decline of thyroid function in your body. 

The reasons that most conventional doctors including family practice doctors and endocrinologists don't believe in this approach (11) is because there aren't clinical studies to fall back on to prove that these therapies are effective. 

But just because there aren't studies proving that they work doesn't mean that they don't!

You have to remember that it costs a lot of money to conduct a clinical study and most of that money comes from pharmaceutical companies who have "skin in the game" in the form of some sort of medication (12). 

They are willing to provide money for a study to see if their drug positively impacts Hashimoto's, but they have little incentive to fund a study for supplements or other natural therapies which may compete with their own medication. 

That means there isn't much incentive for someone to conduct a study to see whether or not diet impacts Hashimoto's. 

After all, who would pay for it? 

But, as I said earlier, it doesn't mean that these therapies are not effective. 

In addition, it's not as if changing your diet or adding exercise to your daily routine is going to cause significant harm to your body. 

You should, however, avoid natural therapies which have outrageous claims or ones which are incredibly expensive and not likely to work. 

I should also point out that not all natural therapies work, and that there is a theoretical possibility that the benefit from these therapies is simply due to the placebo effect.

While I don't believe that this is true, there is a possibility that it could be. 

For more information on therapies (natural and medical), I would recommend that you check out this article

How do you Tell The Difference?

Most of you are probably aware of which condition you have, either hypothyroidism or Hashimoto's. 

Some of you may actually have both. 

But what about the others who aren't quite sure. 

How do they figure out what is happening in their body?

If you fit into this category, then your next step should be to try and figure out exactly what is going on in your body. 

You can do this through basic tests which help you understand how your thyroid is operating and whether or not you are showing signs of having an autoimmune thyroiditis. 

This can be easily accomplished with the following tests: 

  • Thyroid function lab tests - Thyroid function lab tests can tell you how well your thyroid is functioning but they don't tell you why it may be underperforming or overperforming. These tests are always necessary to get but don't always give you a lot of information about the cause of your issue. 
  • Thyroid antibody testing - Thyroid antibody testing can help diagnose and differentiate between the various causes of hypothyroidism and Hashimoto's. If your thyroid antibodies are positive then there is a very high probability that you are suffering from an autoimmune thyroiditis. It's important to note, however, that it's possible for you to have elevated antibodies and NOT have Hashimoto's, so this test is not 100% perfect. 
  • Thyroid Ultrasound - Another easy way to diagnose autoimmune disease is through the use of a thyroid ultrasound. This test can help give you information about the size of your thyroid gland and whether or not inflammation is present. This test is non-invasive and is relatively easy to perform. 
  • Biopsy (rarely necessary) - Lastly, you can also get a thyroid biopsy to definitely diagnose Hashimoto's thyroiditis or other thyroid issues. While this test is by far the most accurate way to diagnose thyroid problems (13), it's also the most invasive of all the tests and carries with it significant risks. It's best to use this test only as a last resort or in cases where a biopsy is absolutely necessary (such as testing for thyroid cancer). 

By obtaining these tests you should be able to figure out what is causing your thyroid problems which can help you determine how to treat your issue. 

My recommendation is to start with basic blood tests including thyroid function lab tests and thyroid antibody tests. 

These tests only require a blood draw and can give you plenty of information. 

In more difficult to diagnose cases, you may be required to undergo ultrasound testing or even a biopsy but this is not common. 

Do you Need Hypothyroid Medication? 

Lastly, I should say a word about thyroid medication. 

Thyroid medication is the treatment for hypothyroidism and it may also be required if you have Hashimoto's thyroiditis. 

Thyroid medication is taken by mouth each and every day and it's supposed to help normalize thyroid function in your body. 

Because your own thyroid gland can't produce enough thyroid hormone on its own, you can take thyroid medication to help supplement the difference. 

But it's important that you don't confuse thyroid medication with other prescription medications. 

While thyroid medication does require a prescription to get, it's unlike other prescription medications because it is an exact replica of the same thyroid hormone that your body produces naturally. 

Other medications, such as blood pressure medication and cholesterol lowering medication, are artificially and synthetically created and are not normally found in your body. 

These medications alter your physiology to create some desired outcome. As this occurs, it's not unusual for people to experience negative and unwanted side effects. 

T3 conversion booster results

Some people taking thyroid medication do experience side effects, but the vast majority should actually feel BETTER when taking thyroid medication. 

If you are taking thyroid medication and not feeling better then that may be an indication that your dose of thyroid medication is off

Because taking too little or taking too much can all cause issues, but not because of the medication itself, instead, it is related to your dose. 

But, even having said all of this, it may not be required for all people with Hashimoto's to take thyroid medication. 

There is a chance that you can "cure" your disease and help your thyroid function normally again on its own if you have Hashimoto's. 

This can also be true of hypothyroidism, but it depends on the CAUSE of the disease. 

If your cause is potentially reversible, then you may not need to be on medication long-term. 

But, if your cause is not reversible, then you may need to be on medication indefinitely. 

This applies to people who have late-stage Hashimoto's where their thyroid gland has atrophied and been destroyed as a result of chronic inflammation. 

People in this category will require thyroid medication indefinitely.

Early stage Hashimoto's, on the other hand, may be able to be treated naturally and long-term use of thyroid medication may be avoided. 

Wrapping it Up

The bottom line?

There is an important distinction between hypothyroidism and Hashimoto's and this distinction has a great impact on your health and your treatment options. 

If you are suffering from hypothyroidism then you absolutely must be tested for Hashimoto's. 

You might be surprised to know that many doctors don't think to do this so it may be prudent for you to ask (even if you've been taking thyroid medication for years!). 

If you have hypothyroidism you should always be searching for the cause of your thyroid problem because once you know the cause then you can attempt to reverse or treat the main issue. 

Note, however, that it may not always be possible for you to do this (some thyroid conditions are not reversible). 

Now I want to hear from you:

Do you have hypothyroidism?

Do you also have Hashimoto's or do you suspect that you do?

Have you been properly tested?

Are you struggling to feel better? Why or why not?

Leave your questions or comments below! 

References (Click to Expand)

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

12 thoughts on “Hypothyroid vs Hashimoto’s: What’s the difference?”

  1. I have hypothyroidism but am suspicious that I also have Hashimoto’s. Mine started at 16 with a goiter and being hyperthyroid. Lasted about 6 yrs then went hypo. I have had trouble finding Dr’s who understand and who really want to work at figuring things out. I have a few cysts on my thyroid which have been biopsied. I am now 66 and I would really like to FINALLY feel well/better.

    • Hi Gloria,

      It can certainly be difficult to find people willing to work with you but it’s not impossible. I would keep at it and try to get tested for your thyroid antibodies the next time you go in. Just note that some people who have had Hashimoto’s may have negative antibodies if their thyroid has been destroyed, so it’s possible to have negative antibodies but still have Hashimoto’s.

  2. Hello
    I’m glad I ran across your site, I have been hypo for years I also have Hashimotos, I would like to find another doctor in my area that can help me with both Hypo and Hashimoto my endocrinologist who I just became a patient with, is following the same protocol that the last two endocrinologists has followed, give me Synthroid change my dosage and send me home, they never talk about or how to treat Hashimoto, I am in the Dallas, Fort Worth area of Texas HELP IF YOU KNOW OF SOMEONE I CAN reach out to set up an appointment…Thanks for reading my message Have a great Weekend.

  3. Hello Dr. Child’s
    I so enjoy your information! I’m 68 years old and
    I have had thyroid issues for 20 years. I’ve had an ultrasound and a biopsy and finally diagnosed as having Hashimoto’s Thyroiditis. I take Levothyroid, 112 mcg daily…and Cytomel, 25mg, one day a week…My TSH has been on a roller-coaster ride forever! When my Thyroid dose is increased…I go into atrial fib…
    I’m exhausted constantly….and have gained 40 lbs, that I can’t lose, no matter how hard I try! I’m trying to figure out how to maintain somewhat of a balance in my body, but there certainly doesn’t seem to be a way. I have labs done every 2 mos….trying to keep my thyroid balanced…

  4. Hi I like most ‘thyroid patients’ in the UK have had Liothyronine taken away and now feel like death!! I suffer pretty much the usual symptoms, exhaustion, aches, and a huge weight gain, this affects my confidence as well as giving me concern for health in general. I had a private blood test and T3 was 3.41, TSH 0.81, TPA 204, Thyroglobulin Antibodies 4000, so pretty much certain it’s Hashimto’s. Only advice here is eat less (I couldn’t!) and go to the gym 2 or 3 times a week …….I can hardly walk up the road some days I am so exhausted. I need tosort me out before taking those steps, however docs can’t see this. I am thinking of starting the 5:2 diet, do you recommend it please?

  5. Good morning,

    I am currently taking synthroid, and have for about 20 years, with dosage changing depending on lab results. Currently my TSH level is 1.53 (normal listed as .35-4.3) However, my T3 Free and my T4 free are low (T3 is 2.64 with range listed as 2.89-4.88 and T4 is 9.6 with range listed as 9.0-19.0). My doc is stumped and sending me to an internal specialist and I am also being followed by a functional medicine specialist. I am wondering if you know of some reasons that might cause low T3 and low T4? I have been following an autoimmune protocol diet for close to a year, with some success in resolving digestive issues, but weight gain is still an issue as is lethargy and hair loss. I am wondering if you might know of a cause of ‘normal’ TSH with low free T3 ans T4 and any possible treatment protocol suggestions?

  6. My thyroid levels were tested for the first time when I was pregnant with my second child and going through major life transitions and stress. I had my 5th child a year ago, and in between that time my levels have varied a lot and I’ve been on and off medication. I have a small goiter. I was told at one point that I DON’T have Hashimotos because my antibodies were negative, but my most recent panels showed positive antibodies. I’m currently on medication, but also doing a “reset diet” in hopes of either getting off medication eventually or at least staying on the lowest dose. I’m just still not sure if I have Hashimotos. Would you recommend seeking confirmation that I do have it?

    • Hi Hannah,

      A thyroid ultrasound would be a reasonable next step, but I don’t think it’s worth it to get a biopsy. If your antibodies are positive and your thyroid lab tests are abnormal, it’s pretty safe to assume you have autoimmune thyroiditis.

  7. I’ve been diagnosed with both hypothyroidism (1992) and Hashimoto’s Thyroiditis (2006), and when I read your story about your mother and your sister, it was as though you had described my own thyroid journey without the happy ending. My case is unlike any of the others posted. I was fortunate to find an endocrinologist that recognized I was unable to convert T4 to T3 and started treating me with Cytomel only in 2006. At that time, Cytomel was made by King Pharmaceutical and it was the only T3 medication made. For the following five years, I was successfully treated with 100mcg of Cytomel daily. However, in 2011, after Pfizer bought King Pharmaceutical and the rights to Cytomel, it changed the formulation from a corn starch filler to a wheat starch filler. On its label, it listed it as a food starch so non-specific. I suffered and my health significantly declined over the course of the next five years to a point of incapacitation. By the spring of 2016, in addition to the digestive and respiratory symptoms my physicians had identified as nonspecific, I had also developed the celiac mirrored rash on both legs and the dental manifestations strongly associated with Celiac Disease, non-Celiac gluten intolerance or non-Celiac gluten sensitivity. About the same time, my daughter was diagnosed with Celiac Disease, and coincidently, Dr. Izabella Wentz had collected signatures for a petition requesting Pfizer change Cytomel’s filler from a wheat starch to a corn starch filler after Pfizer finally disclosed to her that Cytomel contained gluten. Although Pfizer stated it would change the filler from a wheat starch to a corn starch, I tried it again 18 months after I discontinued it and had started taking a compounded T3 medication. I had also started a gluten free diet. Within a few hours after taking the first dose, I became very ill again, and after 10 days discontinued it. The only change Pfizer made to Cytomel was it changed the manufacturer on its label to Monarch, one of it’s subsidiaries. Given the damage to my body I sustained after taking Pfizer’s Cytomel formulation for five years in such a high dose, I developed absorption issues and systemic symptoms that have persisted three years after I discontinued it. I have been unable to find a T3 medication replacement that I can tolerate and effectively controls my symptoms. A month ago, I finally started treatment with T3 compounded with cocoa butter troche, but at 1/3 the dose taken every 6 hours instead of every four hours. Although some days it appears to work much quicker and control symptoms better than others, I am still struggling with hypothyroidism and debilitating symptoms. Although I’ve made dietary changes and have tried supplements found to help others regain, or at least improve, their health, I am still lost and discouraged in a maze I can’t seem to find my way out of or whether the damage inflicted on my body will continue to challenge, complicate or prevent the outcome I’ve fought so hard to obtain. An improved health state and quality of life.

    FYI: Despite on prescription drug lists online that classify Cytomel as gluten free, other patients with gluten issues that tried Cytomel in small dosages added to their treatment with T4 post-disclosure and after Pfizer’s commitment to change it to a gluten free formulation have also complained it made them ill and had to discontinue it. Another problem is posts submitted by patients who started compounded combination formulations of T3 and T4, and said they improved, refer to the T3 in their compounded formulation as Cytomel rather than T3. Their confusion makes Cytomel ratings misleading.

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